18 Year Old App

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					                    Anderson Adult Education Center
                                         Referral 18-21 Year Old
                                               Application
All applicants 18-21 year olds must submit this form and all required documents listed below before
         admission into the Anderson Adult Education GED or High School Diploma classes.


Name________________________________________                               SS# _________________________


Address ______________________________________City                                                    Zip

Phone Number                                     Date of Birth _______________________ Age

Last School Attended _____________________________________________________________

Address of School if outside of Anderson County

* Student's signature__________________________________________ Date
Reason for leaving school:
(Check all that apply)

      Missed too many days resulting in a failing for the year.
      Too old for grade placement.
      Has already withdrawn/dropped out of school.
      Discipline Issues
      Other (Please explain) _____________________________________________________________


                           Section 2 : High School P r i n c i p a l or Guidance Counselor

        Please complete this section if applicant is cleared of all debts owed to your school.

Did this student have?             IEP _____________ 504 Plan ______________
Has this student passed HSAP? MATH Yes _____ No________ Date and Score____________
                              ELA Yes _____ No________ Date and Score____________

      Please attach the following documents for this application to the Adult Education Center.

      1. Copy of official transcript with HSAP test sc ores
      2. Copy of Psychological file (if applicable)


Signature                                              _____Position                        _____Date_____________



      This section is to be completed by Anderson School District Five school administrators.
                           ________________________________
        Fees collected by _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ on ______________________
                                       Adult Education Staff                                        Date
         □ I recommend this student.                           □ I do not recommend this student.
    ____________________________________________________________________________________
            Director of Anderson Adult Education                      Date

				
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posted:11/4/2012
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